Socioeconomic Inequalities in Antibiotic Misuse for Upper Respiratory Tract Infections in Indonesia: A Concentration Index Decomposition Analysis

Socioeconomic Inequalities in Antibiotic Misuse for Upper Respiratory Tract Infections in Indonesia: A Concentration Index Decomposition Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Socioeconomic Inequalities in Antibiotic Misuse for Upper Respiratory Tract Infections in Indonesia: A Concentration Index Decomposition Analysis Vesara Ardhe Gatera, Wahyu Pudji Nugraheni, Bunga A. Paramashanti, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8765460/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract INTRODUCTION : Antibiotic misuse for upper respiratory tract infections poses a significant public health concern. However, little is known about the socioeconomic inequalities associated with antibiotic misuse in these populations. This study seeks to quantify the socioeconomic inequality in antibiotic misuse for upper respiratory tract infections in Indonesia. METHODS : We included a total of 2,434 individuals aged 15 years and over who underwent upper respiratory tract infection examinations from the 2023 Indonesia Health Survey. We measured socioeconomic inequality using the concentration curve and Wagstaff normalized concentration index. We then examined factors contributing to socioeconomic inequality in antibiotic misuse using a concentration index decomposition analysis. RESULTS : The concentration index by household wealth was -0.060 (p<0.001), suggesting more concentration of inequalities among poor individuals. The decomposition analysis revealed that region (21.9%), household economic status (21.0%), knowledge of drug classification (17.8%), knowledge of antibiotic use (16.0%), place of residence (3.9%) and drug literacy (3.4%) explained the pro-poor inequalities in antibiotic misuse. CONCLUSION : This study shows that antibiotic misuse is more concentrated among poorer individuals in Indonesia. Key factors contributing to this inequality include region, economic status, and knowledge of antibiotics. There is an urgent need to address socioeconomic inequalities in antibiotic misuse for acute respiratory infections through targeted education and better access to healthcare. non-prescription antibiotics use decomposition socioeconomic inequality URTI Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 26 Mar, 2026 Reviews received at journal 25 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviews received at journal 14 Mar, 2026 Reviewers agreed at journal 14 Mar, 2026 Reviewers invited by journal 10 Mar, 2026 Editor assigned by journal 05 Mar, 2026 Editor invited by journal 16 Feb, 2026 Submission checks completed at journal 15 Feb, 2026 First submitted to journal 15 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8765460","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603849648,"identity":"5b2273be-09fc-4f74-aab5-88bb1de4473d","order_by":0,"name":"Vesara Ardhe Gatera","email":"data:image/png;base64,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","orcid":"","institution":"Padjajaran University","correspondingAuthor":true,"prefix":"","firstName":"Vesara","middleName":"Ardhe","lastName":"Gatera","suffix":""},{"id":603849649,"identity":"11786c4e-f89c-4f84-bc7f-738a453cbf98","order_by":1,"name":"Wahyu Pudji Nugraheni","email":"","orcid":"","institution":"National Research and Innovation Agency","correspondingAuthor":false,"prefix":"","firstName":"Wahyu","middleName":"Pudji","lastName":"Nugraheni","suffix":""},{"id":603849650,"identity":"36bfa3c1-3483-4eb4-a87d-688c1ff5439c","order_by":2,"name":"Bunga A. Paramashanti","email":"","orcid":"","institution":"National Research and Innovation Agency","correspondingAuthor":false,"prefix":"","firstName":"Bunga","middleName":"A.","lastName":"Paramashanti","suffix":""},{"id":603849651,"identity":"6acd805f-5341-44ff-8f5c-d8f776e3966a","order_by":3,"name":"Dea Anita A. Kurniasih","email":"","orcid":"","institution":"National Research and Innovation Agency","correspondingAuthor":false,"prefix":"","firstName":"Dea","middleName":"Anita A.","lastName":"Kurniasih","suffix":""},{"id":603849654,"identity":"0e5be920-9a7d-48c5-81f4-45455dc2695c","order_by":4,"name":"Sinta Dewi Lestyoningrum","email":"","orcid":"","institution":"National Research and Innovation Agency","correspondingAuthor":false,"prefix":"","firstName":"Sinta","middleName":"Dewi","lastName":"Lestyoningrum","suffix":""},{"id":603849655,"identity":"209508c4-8dc1-4047-b883-0ae92df65bd7","order_by":5,"name":"Syarifah Nuraini","email":"","orcid":"","institution":"National Research and Innovation Agency","correspondingAuthor":false,"prefix":"","firstName":"Syarifah","middleName":"","lastName":"Nuraini","suffix":""},{"id":603849657,"identity":"88f703c3-901e-4fbd-997a-6e352a32e931","order_by":6,"name":"Debri Riski Faisal","email":"","orcid":"","institution":"National Research and Innovation Agency","correspondingAuthor":false,"prefix":"","firstName":"Debri","middleName":"Riski","lastName":"Faisal","suffix":""},{"id":603849659,"identity":"5ad594e8-36c7-44f6-9daa-3defb7e346a4","order_by":7,"name":"Asep Kusnali","email":"","orcid":"","institution":"National Research and Innovation Agency","correspondingAuthor":false,"prefix":"","firstName":"Asep","middleName":"","lastName":"Kusnali","suffix":""}],"badges":[],"createdAt":"2026-02-02 13:23:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8765460/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8765460/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104546635,"identity":"fabc4a8c-2bd8-4222-9659-784d15f0b582","added_by":"auto","created_at":"2026-03-13 07:27:06","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":528925,"visible":true,"origin":"","legend":"","description":"","filename":"SocioeconomicInequalitiesinAntibioticMisuseBMCInfectiousDisease150226.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8765460/v1_covered_b75504ac-49a1-4608-9320-f59e40b8b457.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Socioeconomic Inequalities in Antibiotic Misuse for Upper Respiratory Tract Infections in Indonesia: A Concentration Index Decomposition Analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"non-prescription antibiotics use, decomposition, socioeconomic inequality, URTI","lastPublishedDoi":"10.21203/rs.3.rs-8765460/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8765460/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eINTRODUCTION\u003c/strong\u003e: Antibiotic misuse for upper respiratory tract infections poses a significant public health concern. However, little is known about the socioeconomic inequalities associated with antibiotic misuse in these populations. This study seeks to quantify the socioeconomic inequality in antibiotic misuse for upper respiratory tract infections in Indonesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS\u003c/strong\u003e: We included a total of 2,434 individuals aged 15 years and over who underwent upper respiratory tract infection examinations from the 2023 Indonesia Health Survey. We measured socioeconomic inequality using the concentration curve and Wagstaff normalized concentration index. We then examined factors contributing to socioeconomic inequality in antibiotic misuse using a concentration index decomposition analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003c/strong\u003e: The concentration index by household wealth was -0.060 (p\u0026lt;0.001), suggesting more concentration of inequalities among poor individuals. The decomposition analysis revealed that region (21.9%), household economic status (21.0%), knowledge of drug classification (17.8%), knowledge of antibiotic use (16.0%), place of residence (3.9%) and drug literacy (3.4%) explained the pro-poor inequalities in antibiotic misuse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION\u003c/strong\u003e:\u003cstrong\u003e \u003c/strong\u003eThis study shows that antibiotic misuse is more concentrated among poorer individuals in Indonesia. Key factors contributing to this inequality include region, economic status, and knowledge of antibiotics. There is an urgent need to address socioeconomic inequalities in antibiotic misuse for acute respiratory infections through targeted education and better access to healthcare.\u003c/p\u003e","manuscriptTitle":"Socioeconomic Inequalities in Antibiotic Misuse for Upper Respiratory Tract Infections in Indonesia: A Concentration Index Decomposition Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 07:26:32","doi":"10.21203/rs.3.rs-8765460/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-26T06:07:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-25T22:27:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295688994656555766967019220988766778180","date":"2026-03-17T07:26:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-14T14:19:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319052144482043724934017328296509047992","date":"2026-03-14T11:59:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-10T13:37:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-05T08:33:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-16T05:06:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-15T11:24:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2026-02-15T11:20:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ebfc82b-b4f3-4597-a98a-16bc4637e897","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-26T06:24:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 07:26:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8765460","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8765460","identity":"rs-8765460","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}